Prospective study of second-line chemotherapy for non-small cell lung cancer selected according to EGFR gene status
Fumihiro Oshita, Yohei Miyagi, Takeshi Honda, Shuji Murakami, Tetsuro Kondo, Haruhiro Saito, Kazumasa Noda, Tomoyuki Yokose, Yoichi Kameda, Yuji Sakuma, Masato Obata and Kouzo Yamada
We prospectively investigated the outcome of personalized second-line treatment based on epidermal growth factor receptor (EGFR) gene status in previously treated patients with advanced non-small cell lung cancer (NSCLC).
EGFR gene status was evaluable by LH-mobility shift assay in registered patients. Gefitinib (Gef) treatment was recommended if the patients had EGFR mutation (mEGFR). EGFR gene status was evaluable in 146 patients. Seventy-four of the patients were female, 82 were smokers, and 122 had adenocarcinoma. Overall, 67 patients had mEGFR and received Gef. Forty-nine of 79 patients with wild-type EGFR (wEGFR) received other chemotherapies or radiation but 30 selected best supportive care only as a second-line treatment. Patients with mEGFR survived significantly longer than patients with wEGFR (p < 0.0001). However, the survival of patients who received other forms of chemotherapy was not different from that of patients who received best supportive care only as a secondline treatment in patients with wEGFR. Examination of the association between overall survival after first-line chemotherapy and prognostic factors using multivariate regression analysis showed that mEGFR and response to first-line chemotherapy were independent factors (p=0.003 and p=0.003, respectively). Selection of second-line treatment according to EGFR gene status may be useful for patients with NSCLC.
Keywords: Lung cancer, non-small-cell, EGFR, mutation, chemotherapy, second-line, gefitinib